CHAPTER 4: SCREENING FOR CERVICAL CANCER

Chapter 5: Diagnosis and Management of Precancer 143DIAGNOSIS AND TREATMENT ACTIVITIES AT DIFFERENT LEVELSIn the communityAt the health centre• Support women who have been treated, by encouragingabstinence from intercourse or condom use, helping withremoval of vaginal packing, enquiring about and acting onsymptoms of complications.• Provide condoms to all women. Train them in consistent andcorrect use.• Contact the health centre if the patient has questions that youcannot answer, or if you are concerned about her status.• Keep records and visit women to remind them when they haveto return to the health centre for follow-up.• Track women who do not return for follow-up, on request ofproviders at the health centre.• Perform colposcopy, biopsy and cryotherapy (if providers havenecessary training and equipment).• Refer women who need further care to the district hospital.• Provide routine and emergency follow-up care for womentreated in the health centre and district hospital.• Maintain communication with the district hospital and withCHWs.• Train, supervise, and support CHWs doing home visits, andprovide supplies.• With CHWs, track women who do not return to the centre in atimely manner.5Chapter 5: Diagnosis and Management of PrecancerAt the district hospital• Manage women referred by the health centre (for diagnosisand treatment) and advise women on follow-up.• Refer women with invasive disease and complicationsrequiring higher expertise to the central hospital.• Assist in the training and supervision of CHWs and healthcentre staff.• Maintain two-way communication with health centre staff.At the central hospital• Maintain quality services in the histopathology laboratory.• Manage women who are referred by the lower levels.• Train and supervise workers at lower levels.• Maintain communication with lower levels about referredwomen, their management and follow–up.